FRACTURE OF THE SURGICAL NECK is by far the most common of the fract ures of the upper extremity of the humerus. Under this head are classed all fractures between the line of the epi physial junctures and the insertion of the pectoralis and teres major. They are caused by direct violence or a fall upon the elbow. The displacement is usually slight, but the lower fragment may be drawn up and to the inner side of the upper one, which is then held in abduction. The diagnosis is made by eliciting abnormal mobility and crepitus when the tuberosities of the humerus are firmly grasped and the arm gently rotated. In impacted fractures there is a tender spot just below the tuberosities and the arm is usually held in slight ab duction.
Treatment.—If there is much over riding, reduction can only be effected by traction in extreme abduction. If the fragments are impacted in fair position. or if there is no displacement, as is often the case, any immobilizing dressing will be sufficient. Usually, though, there is some tendency to shortening to be over come by traction and often some abduc tion in the upper fragment that cannot be overcome. To meet these indications various splints have been devised. For abduction of the upper fragment the best treatment is generally to keep the patient in bed and traction by weight and pully (see FRACTURES OF THE THIGH) on the arm held in partial abduction by being bandaged on a triangular pad or a bent metal band fitted into the axilla.
After two weeks sufficiently firm union will probably have taken place for the arm to be abducted. In this position it is maintained for three or four weeks longer, by a plaster mold or circular splint of which the upper edge is molded well over the shoulder to immobilize the joint and which is made light over the forearm (the elbow being bent to a right angle) and heavy over the arm. The whole. is bound lightly to the chest and the wrist above supported by a sling, in order that the weight of the arm may tend to prevent shortening. Any short ening that may occur will be indicated by a rising of the shoulder-cap and must be compensated by weights attached to the elbow. During all this time frequent exercise of the wrist and fingers must be insisted upon.
A variation of the above line of treat ment should be effective in any case. Ambulatory treatment with the arm in abduction is possible, but irksome.
A simultaneous dislocation of the head is treated as above indicated.